Aneurin Bevan Health Board Management and Prevention of Missing Persons Policy & Procedure

Transcription

1 Management and Prevention of Missing Persons Policy & Procedure N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed versions of the document. The Intranet should be referred to for the current version of the document. Policy Number:

2 Contents Page Page 1 Introduction Aims and Objectives Scope of Policy Duties and Responsibilities Defining Missing Persons and Persons Absent Without Leave (AWOL) under the Mental Health Act Guidance on Identifying Missing Persons Persons at Risk of Going Missing Assessing Level of Risk When a Person Has Gone Missing ABHB Actions in Response to a Missing Person Action in Response to a Low Risk Missing Person (Not AWOL) Actions in Response to a Medium Risk Missing Person (including all persons who are AWOL) Actions to be Taken in Response to High Risk Missing Persons Actions to be Taken to Discharge Persons Who Have Been Notified as a Missing Person Actions to be Taken for the Return of Missing Persons Who Are NOT AWOL Actions to be Taken for the Return of Missing Persons Who Are AWOL Unsuccessful Location of Patient or Patient is Harmed Monitoring Arrangements Learning from Missing Person Episodes Missing Staff Members Process for Implementation Equality Statement Training References

3 1 Introduction 1.1 Aneurin Bevan Health Board (ABHB) has a duty of care for the safety of its patients and service users and a responsibility to be vigilant regarding the whereabouts of all patients, particularly those considered vulnerable. At the same time, patients and service users have a legal right to leave ABHB premises unless they are detained under the Mental Health Act 1983 (MHA) or have been assessed to lack mental capacity to make a valid decision regarding their healthcare needs. This policy aims to provide guidance to support staff to undertake the actions required in the event of a patient found to be missing. 1.2 This Policy and associated Procedures and Guidance replace the following documents: Multi Agency Procedure within Gwent for Patients Absent Without Leave: Section 18 Mental Health Act 1983 (As amended by the Mental Health Act 2007) Procedure for Circulating Missing Persons Notifications Received From the CPA Association. 1.3 This Policy has been developed jointly by the ABHB, Heddlu Gwent Police, Blaenau Gwent County Borough Council, Caerphilly County Borough Council, Monmouthshire County Council, Newport City Council, Torfaen County Borough Council and the Welsh Ambulance Services NHS Trust. 1.4 This Policy needs to be read in conjunction with, and supports the implementation of the requirements of following: Mental Capacity Act 2005 (MCA) & MCA code of practice 2005 Mental Health Act 1983 (as amended by the Mental Health Act 2007) & MHA code of practice 1983 Deprivation of Liberty Safeguards (DoLS) Code of Practice 2005 Ward Operational Policy Missing and Absconded Patients Policy Children & Young People 2

4 Discharge Against Advice Policy, Procedure, Form and Information Leaflet Mental Health Act 2007 procedure for s17 leave and s18 absence without leave A Multi Agency Procedure within Gwent for Implementing and Managing Supervised Community Treatment. A Multi Agency Procedure within Gwent for Sections 135 and 136 of the Mental Health Act Procedure for Obtaining a Section 135 Warrant, Mental Health Act 1983 Guidance for Gwent AMHP s Head injury integrated pathway A&E settings (NICE Guidance 56) ABHB Care & Treatment Planning Policy and Procedure Safe and Supportive Observation Policy for Inpatients in Mental Health and Learning Disability settings. Use of Restrictive Physical Intervention Policy Managing Violence and Aggression Policy Health & Safety Policy Lone Worker Policy Security Policy Medical Records Policy Risk Management Policy Datix Incident Reporting Policy Management of Serious Concerns Policy and Procedure 1.5 The following Standards for Health Services in Wales are applicable to this policy Standard 1 - Governance and Accountability framework Standard 2 - Equality, Diversity and Human Rights Standard 3 - Health Promotion, Protection, and Improvement Standard 7 - Safe and Clinically Effective care Standard 8 - Care Planning and Provision Standard 9 - Person Information and Consent Standard 10 - Dignity and Respect Standard 11 - Safeguarding Children and Safeguarding Vulnerable Adults Standard 18 - Communicating Effectively Standard 22 - Managing Risk and Health and Safety Standard 23 Dealing with Concerns and Managing Incidents 3

5 2 Aims and Objectives The aim of this policy is to ensure that key agencies provide a co-ordinated response to people who go missing from ABHB inpatient settings or other premises defined within the policy and have an agreed policy and procedure to follow. The policy and procedure also aims to be effective in preventing, reporting and finding missing persons. The objectives are to: Provide a working definition of what is meant by a missing person. Clarify the distinction between a missing and an AWOL person. Outline a process that must be followed when a person goes missing and when the person is found and returned to the health setting. Provide guidance aimed to support staff to distinguish between people considered at low, medium and high degree of risk to self or others as a result of going missing. Provide standardised forms and contact numbers. Define the roles and responsibilities of staff in Aneurin Bevan Health Board, Heddlu Gwent Police and the Local Authority. Promote proactive actions that can be taken to prevent missing person episodes. 3 Scope of Policy 3.1 This policy applies to all patients or service users aged 18 and over, receiving interventions/treatment within ABHB premises. 3.2 This policy does not apply to children or young people under the age of 18. Colleagues should refer instead to the Missing and Absconded Patients Policy Children & Young People. 3.3 This policy does not apply to the provision of healthcare services to inmates of Usk or Prescoed prisons. Any missing person episodes in these cases will be managed in accordance with Her Majesty s Prison (HMP) protocols and procedures. 4

6 3.4 This policy provides guidance for staff on the steps to take if colleagues go missing during their working hours (see section 19). 4 Duties and Responsibilities 4.1 All ABHB Staff All staff employed by Aneurin Bevan Health Board are responsible for the implementation of this policy and procedure. All staff are expected to work in cooperation with partner agencies and colleagues from the Police, Local Authorities and the Welsh Ambulance Services NHS Trust as appropriate. 4.2 Police To assist the Nurse/Person In Charge, Senior Manager and Medical Lead Clinician ABHB/Local Authority in locating missing persons and to assist the return of AWOL persons, after agreement regarding the level of risk and level of response with the Nurse/Person in Charge of the ward/department. 4.3 Divisional Senior Managers To ensure that all ABHB premises under their remit have local search protocols in place. To ensure that care premises under their remit have local posters and information leaflets in place to advise patients, service users and visitors of their responsibility to inform staff, the person/nurse in charge when they leave the area (e.g. canteen visit, cigarette break) whenever they wish to leave the ward care setting. To ensure staff receive appropriate training to operate this policy effectively. 5

7 5 Defining Missing Persons and Persons Absent Without Leave (AWOL) under the Mental Health Act A missing person is any patient or service user whose unknown whereabouts and continued absence is a cause for concern. This could be from a clinic where they were due to be seen for a medical condition. This could be from any inpatient or day-case ward. This could be informal patients in Mental Health settings. 5.2 Only persons who are formally detained under the Mental Health Act can be considered as AWOL. Any person detained or liable to be detained under the Mental Health Act (MHA) who is absent without leave (AWOL) is also a missing person. A person is liable to be detained when there is a completed application by an Approved Mental Health Professional (AMHP) but the person absconds before he/she can be conveyed to the hospital where he/she is liable to be detained. For further information, please see appendix 10. All persons who leave the hospital where they are detained under the Mental Health Act, without authorised S.17 leave are classed as missing persons. This includes detained persons who are known to be at home without authorised leave or after their leave period has expired. Detained persons are classed as missing even though their whereabouts are known, and are therefore AWOL. People who are subject to Community Treatment Orders remain liable to be detained under section 3 of the Mental Health Act. Therefore, individuals who are subject to recall will be considered as AWOL if they abscond either before or after they are readmitted to hospital. Also person on Community Treatment Orders, who are subject to a residence condition, will be classified as AWOL if they abscond from or leave permanently the place where they are required to live. 6

8 People who are subject to Guardianship may be required to reside at a particular place. Any person on Guardianship, who are subject to a residence requirement, will be classified as AWOL if they abscond from or leave permanently the place where they are required to live. People who are subject to Deprivation of Liberty Safeguards are not allowed to leave a particular place. Any person who absconds from the place they are required to remain at will be classified as AWOL. 6 Guidance on Identifying Missing Persons 6.1 Every potential missing/awol person incident must be assessed based upon its individual clinical circumstances, risk assessment, WARRN assessment. 6.2 If it is known or believed that the individual does not have the mental capacity to make a decision in relation to ending their treatment or leaving the premises, the best interest decision making process should be adhered to, which would include activation of this policy. 6.3 The principles of the Mental Capacity Act, which apply to this decision making are: Principle 1: A person must be assumed to have capacity unless it is established that he lacks capacity. Principle 2: A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success Principle 3 A person is not to be treated as unable to make a decision merely because he makes an unwise decision Principle 4 An act done, or decision made under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests. 7

9 Principle 5 Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person s rights and freedom of action 6.4 Where there is no evidence that the person lacks mental capacity to make the decision to leave the premises and/or cease treatment, this policy is unlikely to apply unless the risk assessment recognises specific concerns. 6.5 All persons detained under the Mental Health Act, whether absent from the premises where they are detained or failed to return from Section 17 leave, are AWOL and must be classified as missing. An assessment of risk should be carried out by the ward staff in line with this policy. 6.6 Any person subject to Supervised Community Treatment, who having been recalled to hospital and goes missing before they can be returned to hospital or leaves the hospital during the 72 hour period of recall, should be classified as missing and risk assessed accordingly. 6.7 Any person subject to Guardianship who has left their required place of residence without the knowledge and agreement of people responsible for their care should be classified as missing and risk assessed accordingly. 6.8 Any person subject to Deprivation of Liberty Safeguards (DoLS) who has left their required place of residence without the knowledge and agreement of the managing authority responsible for their care should be classified as missing and risk assessed accordingly. 6.9 Before a person is classified as missing, searches of the ward and/or grounds must be undertaken, co-ordinated by the Nurse/Person in Charge. This should take no more than minutes dependent upon risk level and staff must follow the agreed search checklist for the ward/unit (see appendix 3). 8

10 6.10 Similarly, contact must be made, where possible, with family, friends or other persons who may be aware of the person s immediate whereabouts. 7 Persons at Risk of Going Missing 7.1 Identifying persons at high risk of going missing There is no definitive list of reasons that lead to individuals going missing, however the following factors may provide guidance for staff as to those persons who are more likely to absent themselves from care premises. Where these factors are recognised, care plans should be developed which recognise this risk. Those who absent themselves deliberately for social or personal reasons Those who unknowingly become absent as a result of confusion or disorientation (e.g. due to dementia, head injury, etc) Those with a previous history of absconding from either hospital or home. This information may be obtained from patients medical records or may be volunteered by patient or relatives/carers Is restless or displaying agitated or anxious behaviour Is wandering around the ward Is confused Is a smoker Is mobile Has made a statement of intention Has or is suspected of consuming alcohol or drugs, particularly post-overdose Within Emergency Department, has arrived by ambulance but the Welsh Ambulance Services NHS Trust standard operating procedure Hospital Pre-alert and Patient Handover Process has not proceeded to detailed and holistic handover stage. 7.2 Actions aimed at reducing the risk of persons going missing Developing rapport and building person centred care 9

11 Nursing patients in most appropriate care setting/area of ward to optimise visibility and provide appropriate support/interventions Ensure all staff are made aware of those patients who have been identified as high risk Ensure appropriate allocation of staff to care for patient in order that extra observation can be provided Regular observation of patient identified as high risk Appropriate placement in an environment that supports observation Provision of distraction therapy, i.e. activities, games, etc Staff need to be aware of potential additional risks developing during busy times on wards when observation is more difficult due to the level of activity (e.g. during another incident, ward rounds, medication rounds, etc). A person who wants to leave may take this opportunity to abscond. Patients will be issued with wrist bands where appropriate. In Mental Health and Learning Disability wards, a protocol for photographic identification will be used (see appendix 8). 8 Assessing Level of Risk When a Person Has Gone Missing 8.1 There are three categories which are based on the Association of Chief Police Officer s risk assessment model:- Low: Medium: High: There is no apparent threat of danger to either the person or another person. The risk posed is not immediate, but over time is likely to place the person in danger or render them a threat to others. The risk posed is immediate and there are substantial grounds for believing that the subject is in danger because of their own vulnerability or mental state or the risk posed is immediate and there are substantial grounds for believing that the public is in danger through the subject s mental state. 10

12 8.2 The categorisation of the level of risk is not final and may be revised in the light of further information, changed circumstances, prolonged period of absence. 8.3 As part of ABHB s responsibility to provide a safe and secure care environment, steps should be taken to assess the risk that admitted persons may go missing and ensure that their individual care plan includes appropriate measures (e.g. frequent observation, distraction activities, making a note of their appearance to support swift response if necessary) to minimise risk. 8.4 To assist the completion of missing person forms (see appendices 3-7) all persons assessed as at high risk of going missing, highly vulnerable or pose risk to others should have a description of their main physical characteristics and/or photographs where appropriate (please refer to appendix 8) included in the clinical notes on triage/admission (see appendix 1 for proforma). 8.5 At the point of admission, additional information regarding a high risk person s interests/hobbies, important places or people and usual mode of transport should also be recorded and shared. Also include how mobile they are. 9 ABHB Actions in Response to a Missing Person 9.1 The Nurse/Person in Charge must always move immediately to contacting the police using 999 where there is clear evidence of serious risk of harm to the missing person or others. 9.2 Nurse/person in charge of the ward/ unit/ department should: Decide when persons should be classified as missing/awol. Assess and escalate the concern when a person has been classified as missing/awol. Oversee and manage the implementation of the missing persons procedure including liaison with police, families and any relevant agency. 11

13 Complete a risk assessment and initiate and coordinate the actions followed if persons are classified as missing. The actions are detailed within the missing persons forms as follows: Coordinate and conduct a systematic search of the premises and grounds where appropriate; this has a unit specific agreed plan (see appendices 3 and 4). Undertake agreed risk assessment to confirm the risk category of the missing person (see Appendix 6). Complete missing person details form (appendix 5) and contact police, informants and other agencies, where appropriate. Inform and/or consult with the Senior Nurse/Ward Manager or those on call delegated or other relevant person in charge of the premises. Inform relatives and any other relevant individuals. Complete Datix incident form and update clinical records. Inform Consultant/Responsible Clinician for the patient or delegated on call consultant. Please see appendix 2 for missing person action chart. 9.3 The Nurse/Person in Charge must follow the procedural pathway and complete an assessment of the level of risk. This task involves: Considering the person s most recent risk assessment Considering the person s care plan and most recent entries in the clinical notes. Considering the level of risk in the light of recent behaviour, the circumstances of the person going missing, the person s legal status and any factor considered relevant at the time of assessment Complete missing person procedural pathway and checklist (appendices 2-5) Complete the missing person risk assessment form to decide if it is necessary to inform police (appendix 6). 9.4 The Nurse/Person In Charge must inform the Unit Senior Nurse (or equivalent) or covering senior nurse (or equivalent) including on call arrangements at the time when a person is classed as missing (see section 5 above), as soon as practicable whenever: 12

14 Staff resource management are believed by the Nurse/Person in Charge to be required, impacting upon this policy There is a clear and present level of risk immediately evident There are barriers to implementing this policy, which are not resolvable by the Nurse/Person in Charge The Nurse/Person in Charge requires Senior Nurse to attend the site or provide telephone advice. 9.5 Whenever senior medical/psychiatric advice is required to establish the level of medical or psychiatric risk, the Nurse/Person In Charge must at all times consider the degree of risk balanced against the level of knowledge and skill required to determine action, e.g., it may not be appropriate to seek advice from junior doctors. 10 Action in Response to a Low Risk Missing Person (Not AWOL) 10.1 The Nurse/Person in Charge will ensure that the following actions, also detailed in the missing person Action chart and Record of Processes (appendix 2, 3 & 4) are always taken to ensure consistently robust attempts are made to find the missing person as swiftly as possible: Ask other persons/residents about sightings of the missing person Check the immediate vicinity of the ward and grounds Check if the person has taken any known or logged personal possessions or money with them. Search patients room for any notes they may have left Complete a missing person s form Notifying the responsible doctor/responsible Clinician as soon as practicable Inform the person s nearest relative (or other named contact) Inform the community team (CMHT or other) as soon as practicable (where appropriate) Inform the Senior Nurse or equivalent Inform hospital reception (where available) 13

15 Check hospital CCTV for direction of travel (where available) Contact local taxi firms Record incident on Datix 10.2 The Nurse/Person in Charge will keep the on-call manager/senior Nurse informed as necessary The hospital/unit grounds will be searched in line with the Missing Persons Checklist (appendix 4). The initial responsibility for searches will lie with ABHB staff in the hospital, but they will liaise with police if the level of risk should increase (see 8.1) 10.4 Enquiries will be made with the person s relatives or others, friends, social services, where indicated The progress of a low risk missing person episode will be monitored continually. In the light of the time the person is missing and any new information that comes to light a decision may be taken either to upgrade the episode to Medium Risk or to discharge the person from hospital (in which case the missing person episode is ended) Police will not normally be notified of low-risk missing persons. The rationale for this is that missing patients are not missing persons. Low risk patients pose no risk to themselves or others and until they are established to be such are not within the remit of the police. Any informal patient may leave hospital without permission if they choose to do so In relation to low risk patients reference should be made to the Association of Chief Police Officers, Interim Missing Persons Guidance 2013 (ACPO Guidance 2013) see section 23, on the distinction between missing and absent persons. The definition of absent is: A person not at a place where they are expected or required to be. The `absent category should comprise cases in which people are not presently where they are supposed to be and there is no 14

16 apparent risk. `Absent cases should not be ignored, and must be monitored over periods of time with consideration given to escalating to missing if there is a change to the circumstances that has increased the level of risk. (ACPO Guidance 2013 page 5) 11 Actions in Response to a Medium Risk Missing Person (including all persons who are AWOL) 11.1 The Nurse in Charge will ensure that the following actions are always taken: Completing all actions for a low risk missing person Informing the responsible Police force (not until the initial basic checks have been carried out by the hospital to try and locate the patient i.e. searches; contacting family, etc). Contact local A&E and Mental Health Units where felt to be necessary The Senior Nurse/on-call manager will check that the nurse in charge has completed the above actions and escalate as necessary The hospital/unit grounds will be searched by hospital staff immediately if there are reasonable grounds for believing that the person may be there Where there is recent information that a person is off-site (e.g. at home) the site may not be searched immediately, but will be if that person fails to appear and the possibility that they have returned to the site needs to be ruled out The purpose of faxing the Missing Person Alert to local A&Es and Mental Health Units is to alert them to the possibility that the missing person may present there. This is an exceptional measure and is also limited to local units, generally those within ABHB boundaries unless the individual has made a clear statement of intention about going to a particular location. Only very exceptionally is there a national distribution throughout the NHS of missing person details and this would be informed by Executive level discussion (see 12.2). 15

17 11.6 The police will be immediately notified by telephone once the initial checks identified above have been completed and provided with all available information. Staff to await arrival of police officer For non-awol persons, the Nurse/Person in Charge will be expected to provide police colleagues with a clear rationale of why they feel the individual is at risk. In most cases this will result from an individual, who is known or believed to lack capacity and requires additional healthcare, going missing, where there are specific concerns about the person s vulnerability or risks to others Where any individual makes a capacitous decision to leave a health setting. The court has stopped short of making decisions for mentally capacitous but vulnerable adults. However, it has used its inherent jurisdiction to support these individuals to make an autonomous decision. No referral to the police should be made without reasonable attempts to assist a person to make a decision, when presenting health problems indicate a likelihood of risk to the wellbeing of the individual. If the patient is known to have capacity or if they are assumed to have capacity because there has not been sufficient reason to undertake an assessment of capacity treatment police colleagues may not be in a position to assist Police will deal with medium risk missing persons as a high priority and will: - Activate the police missing person s procedure - Make enquiries, liaise with relatives, issue alerts as necessary - Carry out their own risk assessment - Review the case periodically with hospital staff - Return persons to hospital when necessary Police should consider contacting Missing People for assistance with publicity and support for families. Missing Persons Helpline is free and available to call or text on or @missingpeople.org.uk. 16

18 11.11 When the person is subject to Protecting Vulnerable Adults procedure the local Protecting Vulnerable Adults team will be notified (even if the person is found, it may be appropriate for the episode to be notified to the Team) Legal requirements in relation to the MHA and MCA must be taken into account at all times. In particular it should be remembered that: - o An AWOL person is missing even if it is known where they are and where the person appears safe and well. An AWOL person is unlawfully at large and therefore ABHB together with local police have a duty to return the person to hospital. 12 Actions to be Taken in Response to High Risk Missing Persons 12.1 All actions are as for medium risk persons, but there must be throughout a sense of the urgency with which all parties need to act. For instance, there must be no delay between a person being absent and being defined as missing for high risk persons. Police stress the need for immediate reporting in order to maximise the chances of persons being found. This does not negate the need for hospital staff to still carry out the basic checks as for low/ medium risk even after police have been informed Exceptional consideration will be given to distributing missing person details throughout the NHS. Any request to do this will be made to ABHB s Communications Manager (who will in time liaise with the Medical Director, as Caldicott Guardian for ABHB). 13 Actions to be Taken to Discharge Persons Who Have Been Notified as a Missing Person Low risk persons may be discharged in their absence. They are of voluntary status and therefore entitled to absent themselves from hospital. Before a person is discharged it should be clear that either (a) they are refusing to return to hospital or (b) (where this is not known) their absence does not lead to 17

19 heightened risk and therefore occasions no particular alarm. Decisions to discharge persons in their absence will usually be made at ward rounds and documented in the clinical notes All other missing persons must be followed up via Care and Treatment Planning or other reviews until either the person is found or there is no reasonable hope of their being found so that the case is closed to ABHB and the person recorded as discharged from a hospital bed For persons detained under the Mental Health Act this can only be done by the Responsible Clinician The above should be documented on epex/ e-discharge form. 14 Actions to be Taken for the Return of Missing Persons Who Are NOT AWOL 14.1 When a missing person has been located, the person who finds them should undertake a proportionate capacity assessment. This does not have to be a full clinical assessment, rather the principles of the mental capacity act need to be adhered to as far as is possible (see 6.3.). In practice a few questions to judge: whether or not the person has an impairment or disturbance in the functioning of their mind or brain and; does or does not understand the choice to return to hospital or place of treatment. is aware of the consequences of their decision and is consistently able to communicate their view. Following the outcome of this assessment the alternative options are outlined below Person with capacity does not wish to return: If a missing person has made a capacitous decision that they do not wish to return to healthcare premises to continue their treatment, this decision must be respected and they cannot be compelled to return. Individuals have the right to make decisions about their future care, even if these decisions are considered to be unwise. 18

20 Where a missing person chooses not to return to continue treatment, this must be documented in the clinical notes and the Datix incident form. They should be formally discharged and the appropriate persons informed. Dependent upon the situation, it may be appropriate to consider if there are any POVA ramifications to the failure to complete treatment. Consideration should be given to liaison with other agencies on this issue Person without capacity does not wish to return: For a missing person who does not have capacity about their current health treatment and does not wish to return to continue their treatment, the principles of the Mental Capacity Act will apply. The best interest of the patient to receive care must be balanced with their wish to remain away from hospital. In these instances, where there are significant concerns around the risk to the individual, the Mental Capacity Act gives the power to return people to a place of safety to receive care, but this decision must be carefully balanced against the impact of returning an unwilling patient. In these cases, consideration should be given to any potential methods of providing treatment and care which do not involve hospital admission and whether it would be appropriate to discharge the patient. A person without capacity who refuses to return where it is believed to be in their best interest could be returned to hospital using reasonable restraint if necessary and proportionate to their needs. However, this must be an option of last resort, having exhausted all avenues of negotiating a safe return. If restraint is utilised, this must be for the minimum possible length of time and using the least restrictive methods to support a safe transfer. This should only be undertaken after a mental capacity assessment and best interest decision or where there are recognised risks to life and limb. 19

21 14.4 Return of the missing person: The Health Board has responsibility for undertaking a risk assessment and making appropriate arrangements to convey the missing person back to the relevant care setting. A pragmatic approach to conveying the missing person should be made, based upon their health needs and who they are found by. This might consist of return with a relative/carer, return via ambulance or with police. On the return of the patient to the clinical area, priority must be given to undertaking a capacity assessment and reviewing the individual s care plan on this basis. Staff should complete Missing Persons Form 5 (see appendix 7) and the person s risk assessment should be reviewed to recognise the increased potential for future absconder episodes. The incident should be fully documented in the clinical notes, and Datix incident report updated As soon as missing persons are found and returned the appropriate/following people must be informed including: - - Responsible Clinician - Police (if they do not already know) - Nearest and/or any involved relative or carers. - Community Team - Ward Manager - Senior Nurse- - Safeguarding Adults team (if appropriate) - Missing People where they have been contacted for assistance. 15 Actions to be Taken for the Return of Missing Persons Who Are AWOL 15.1 Persons who are AWOL and found by the police either at home or in a public place will normally be returned by the police. 20

22 15.2 If information is received that the patient is at home or another address, then the Health Board has responsibility to confirm the accuracy of this information e.g. through CMHT visit Following confirmation of the patient s whereabouts a risk assessment should be carried out regarding the most appropriate form of conveyance to return the person to hospital. The responsibility for co-ordinating this risk assessment lies with the Health Board Regard must be had to the time period for detained persons, after the expiry of which persons are no longer liable to be detained. Note: that any S.3 or S.37 person who goes AWOL is liable to be detained for 6 months from the date on which they went AWOL, irrespective of the original section expiry date (see appendix 9) Following the outcome of the assessment the Health Board will remain responsible for co-ordinating the conveyance of the person A person who is liable to be detained under sections 2,3,4 5 or 37 of the Mental Health Act may be returned to the hospital by an Approved Mental Health Professional (AMHP), any officer on the staff of ABHB, any police officer or any person authorised in writing by the Hospital Managers (see Code of Practice for Wales Chapter 29). This includes persons recalled under Supervised Community Treatment who go AWOL within the 72 hours period of recall There is no automatic statutory responsibility for the police to return patients (detained or otherwise) to hospital. However in terms of practicality and urgency it may be difficult to release a member of the ward staff from a hospital in order to allow them to retrieve missing persons. Similarly where the person is refusing to return it may be unsafe for ABHB staff alone to enforce their return, even where staff are available (see 15.3). In these circumstances police help should be negotiated where possible Section 17 of the Police and Criminal Evidence Act 1984 creates a power for police to enter premises (within certain constraints) to 21

23 effect an arrest, to save life or limb or to recapture a person. Police have no powers to enter premises to return any person. In regard to persons who are liable to be detained under the Mental Health Act, Section 17(d) of the Police and Criminal Evidence Act 1984 allows a constable to enter a premises that he/she knows without doubt that the person is inside (i.e., they have seen them) and effect an arrest for the purpose of recapturing any person whatsoever who is unlawfully at large and whom he is pursuing; or under Section 17 (e) police may enter any premises for the purpose of saving life or limb or preventing serious damage to property If it is believed that entry to the premises will not be granted for the purposes of returning an AWOL patient, then the Health Board may need to consider obtaining a warrant under Section 135 (2). (See appendix 9 for details) A person who is found outside of the ABHB catchment area may have to be taken and admitted to the psychiatric hospital local to the area and subsequently transferred to an ABHB unit by ambulance. Where a person who is AWOL is located in another hospital it remains the responsibility ABHB to coordinate the return of the missing AWOL patient. In practice there is usually some negotiation between the hospitals to ensure the person s efficient and safe return For summary of powers for the return of AWOL persons see appendix As soon as missing persons are found and returned the appropriate/following people must be informed including: - Responsible Clinician - Police (if they do not already know) - Nearest and/or any involved relative or carers. - Community Team - Ward Manager - Senior Nurse- - Safeguarding Adults team (if appropriate) - Missing People, via Missing Persons Helpline, where they have been contacted for assistance (see 11.10) 22

24 15.13 Actions taken after missing persons who is AWOL are returned must include a review of their Risk Management Plan (WARRN) to reduce the likelihood of the person going missing again. This must in turn be reflected in the person s Care and Treatment Plan and communicated to all staff The above should be documented on epex and the Datix incident report updated For guidance on the powers available within the Mental Health Act for the return of AWOL persons and the requirements on staff to assess depending on the length of the AWOL period, see appendix Unsuccessful Location of Patient or Patient is Harmed 16.1 In the event of the patient being harmed or not located after an agreed time span, a formal Serious Incident investigation will take place (see ABHB Policy and Procedure for the Management of Serious Concerns). Reports will be required from all staff within and outside the Health Board who have been involved in the incident. 17 Monitoring Arrangements 17.1 To ensure that the incidence and outcome of missing person episodes is kept under scrutiny, ABHB will monitor missing person episodes as follows: The Nurse/Person in Charge will enter missing person episodes on Datix, which is part of ABHB s governance and risk management system Missing Person incidents will be reviewed via divisional Quality and Patient Safety forums, and more significant incidents will be also be dealt with individually via Serious Untoward Incident reviews. 23

25 The Mental Health Act Manager will periodically compile a report on AWOL persons to be considered at the Gwent Mental Health Implementation Group. 18 Learning from Missing Person Episodes 18.1 Missing persons take up time and other resources for ABHB staff, police and others. Any reduction in missing persons will result in the redirection of resources to direct person care. Additionally missing persons are often at heightened risk to their health, safety or the safety of others Post incident actions should include a thorough debrief with the patient to discuss why they went missing, what they did when missing and where they went. Record the information disclosed for future missing episodes When persons have returned there should be a review of their care plan to try to address the reasons why they went missing and prevent a re-occurrence. If necessary, where they are a detained person, the continuance of Section 17 leave, should be reviewed If a patient goes missing on more than 3 occasions, a meeting between all interested parties is convened to discuss the case and try to prevent further missing reports The monitoring of missing person episodes at the organisational Quality & Patient Safety Forums. They will pay particular attention to the organisational lessons that can be learnt to reduce missing person incidents. 19 Missing Staff Members 19.1 All staff members are expected to maintain a record of any appointments which would lead to them being absent from their normal base (e.g. daily diary, shift rota) Prior to leaving their normal base, it is good practice for staff to ensure that they have advised a colleague that they are leaving, where they are going and how long they expect to be gone. 24

26 19.3 For further information please refer to Appendix Process for Implementation 20.1 This policy will be posted on the ABHB Intranet Site, where all staff can access it Ward/Team Managers will brief staff about this Policy Senior Nurses (or equivalent) will ensure that all areas within their responsibility have local search policies. For sites where services from a range of Divisions operate from, Senior Nurses will liaise at a Divisional level to ensure that search checklists are consistent for all services across the site. 21 Equality Statement This Policy recognises the possibility for procedures relating to missing persons to be unequally applied to different minority groups, particularly black ethnic minority groups. This could result in a lower level of concern for some persons than others due to ethnicity. Ethnicity is also implicated in that disproportionate numbers of some ethnic groups are admitted to hospital, including on a section, than others. The intention is that all ethnic groups and other minorities will be treated equally. This will be specifically monitored under the arrangements described in section 17 above. 22 Training 22.1 On call managers, Ward/Unit and Team Managers are responsible for briefing staff about the requirements of this policy. Ad-hoc (bespoke) training on this policy will be carried out as necessary This Policy will feature in regular MHA Introductory and refresher training Gwent Police senior officers will be responsible for ensuring the content of this policy is delivered to all relevant officers and staff. 25

27 22.4 Local Authority. Relevant local authority staff will be invited to attend training put on by ABHB 22.5 Welsh Ambulance Services NHS Trust senior officers will be responsible for ensuring the content of this policy is delivered to all relevant officers and staff. 23 References The Mental Health Act 1983 The Code of Practice to the Mental Health Act 1983 The Mental Capacity Act 2005 The Code of Practice to the Mental Capacity Act 2005 The Deprivation of Liberty Safeguards Interim Missing Persons Guidance - Association of Chief Police Officers

28 APPENDIX 1 PATIENT IDENTIFICATION FORM To be completed on admission (Mental Health & Learning Disabilities) or when risk assessment identifies patient as being at high risk of going missing (non-mental Health & Learning wards) Personal Details Surname (including Maiden Name Forename(s) Male/Female Hospital/Epex Number Date of Birth Ward/Unit Preferred Language Known Risk Issues Previous history of going missing? Known places to frequent Significant risk factors (uses weapons/harm to others/harm to specific individuals/harm to self) 27

29 Description A supporting photograph can be taken of the patient for this purpose only if they have capacity and consent to this. Complexion Height Ethnicity Build Colour of Hair Length/Style of Hair Colour of Eyes Spectacles Yes No Facial hair Dentures Yes No Shoe Size Accent Visible Marks, Scars, Tattoos & Distinguishing Features (include location on patient) Name & Signature:.. Date form completed/updated:.. 28

30 APPENDIX 2 MISSING PERSON ACTION CHART THESE MEASURES ARE A GUIDE ONLY and the action may be escalated giving regard to prevailing condition of the patient e.g. those attending emergency departments, the time of day, weather considerations, etc. Timescales given are time elapsed after person discovered missing. Low Risk First 15 minutes minutes Medium Risk First 15 minutes minutes Action Nurse in Charge (or equivalent) Co-ordinate search of immediate area (ensure adequate staff cover remains on ward/unit). Try patient s mobile phone Enquire with other staff/patients about patient s last known movements/location. Obtain full description of clothing & any belongings carried by missing patient from last witness and communicate to relevant parties. Contact relatives (dependent on time patient last seen) and check that the patient is not there, alert relatives to the situation. A request must be made that the hospital is informed if the patient appears or makes their whereabouts known to them. Complete Missing Person risk assessment (Appendix 6/ Form 4). Alert police (high risk only) giving core information: basic description, time person went missing, are they mobile, do they have money, do they lack capacity, are they able to engage (e.g. use public transport). IF PATIENT NOT LOCATED Nurse in Charge (or equivalent) Complete Missing Person Details Form 3 (Appendix 5) and commence Record of Process Form 1 (Appendix 3). Alert porters and security staff where relevant to commence search during routine duties. Alert switchboard & main reception. Alert neighbouring wards/departments and any that the person may have visited and request that they search & feedback their areas for noting on timeline report. High Risk First 15 minutes minutes 29

31 70 minutes 2 hours minutes Contact local taxi firms (as per Missing Person Site Search Protocol (Form 3, Appendix 4) to confirm whether patient has been picked up. If relevant inform local A&E department that missing person may attend (this may include any/all of RGH, NHH, YYF and/or UHW dependent on location). This would normally be an exceptional measure if there are grounds to suspect that the person may present there. If relevant notify any concerned or at risk parties. IF PATIENT NOT LOCATED Police For high risk patient, Police will lead search of site Nurse in Charge(or equivalent) Alert on site manager. Alert police (medium risk only) Complete Datix incident report Discuss search parameters with police minutes 2-4 hours 4 hours + 90 minutes 3 hours 3 hours + On Site manager (NHH, RGH & YYF) For low and medium risk arrange for a site search as per Missing Person Site Search Protocol (Form 3, Appendix 4). Consider CCTV trawl (consider dispatching nurse from ward for identification). IF PATIENT NOT LOCATED On Site manager RGH, NHH, YYF/Nurse in charge all for other locations Reassess risk with Nurse in Charge & Patient s doctor. Update relatives regarding current situation. Enquiries made with person s relatives, friends, social services if thought to be necessary. Feedback to ward staff. Inform Divisional Senior Manager/Executive on-call IF PATIENT NOT LOCATED On site manager RGH, NHH, YYF/ Nurse in on call for other locations Continually reassess every 2 hours until situation resolved. Record actions each time on Missing Person Form 1 (appendix 3) 1 2 hours 2 hours + 30

32 Hand over to next manager coming on duty if applicable with the relevant paperwork. For low/medium risk patients, consider if discharge is appropriate. For high risk patients, consider with police and Divisional Senior Manager/Executive on-call if media alert is appropriate. Ensure relatives have daily updates. PERSON IS LOCATED PERSON IS NOT LOCATED OR On Site manager RGH NHH YYF/Senior Nurse on call for other locations Stand down search Establish medical condition of patient Establish if any treatment is necessary as a result of missing episode Determine if patient should return to hospital or be formally discharged. Inform relatives If patient remains in hospital care, review risk assessment & care plan. Complete Missing Person Form 5 (Appendix 7). Update Datix incident report. PERSON IS HARMED As per Person is Located Initiate formal Serious and Untoward Incident Investigation (see ABHB Policy and Procedure for the Management of Serious Concerns.) 31

33 APPENDIX 3 MISSING PERSON FORM 1 NURSE IN CHARGE (OR EQUIVALENT) RECORD OF PROCESSES NAME OF MISSING PERSON/PATIENT (Patient label or UA CTP FRONT SHEET) WARD/DEPT: Date: Nurse in Charge Full Name:.. (Initiating missing persons procedure) Search Commencement Time:... (unit search to be completed within 15 minutes) Delegate Name and role of Staff:.. WARD/DEPT SEARCH PROTOCOL (PRINT) SEARCH RECORD SHEET Check Bed State (Wards) Transfers and discharges Concealed areas, locked doors, Under Beds, Behind Curtains checked Cupboards or wardrobes checked Day Rooms checked Visitors Rooms checked Corridors checked Toilets/Bathrooms checked Check All Rooms Within Ward e.g. Sluice, Storage, Admin Offices Immediate local search plan i.e. Outside of ward, contact reception, porters, neighbouring departments as per site search plan COMPLETED TICK YES NO 32

34 Search Nurse Signature Person Not Found Nurse in Charge Continue Nurse in charge gather patient notes, clinical demographic details. Complete risk assessment, referral admission details and identification description See information prompt Phone patient s mobile phone (if known) FOUND STOP Time Continue Time COMPLETED TICK YES NO Contact next of Kin if Known Contact Police for High Risk Persons Additional Advice sought responsible medical staff Contact any at risk persons Time Time Time Additional search activity agreed senior Manager ie to include external boundary (to be agreed locally, see form 2) Record Initiate Datix record Completed time RISK LEVEL HIGH Alert Police immediately POLICE LEAD ON SITE SEARCH MEDIUM LOW Other Actions Taken: Nurse in Charge Signature:... 33

35 APPENDIX 4 MISSING PERSON FORM 2 MISSING PERSON SITE SEARCH RECORD This search will not extend beyond the boundaries of ABHB grounds. The site search is a local process agreed for each individual site by senior managers. NAME OF MISSING PATIENT: STAFF MEMBER CO-ORDINATING PROCESS:... SITE: BUILDING:... DATE:. TIME COMMENCED:. Corridors AREA COMPLETED (TIME) NAME SIGNATURE Canteen Plant rooms Outpatient departments Therapies departments Grounds Other (specify) External Boundary (to be agreed locally) Any external risk areas Local taxi firm numbers: (to be completed for each site) 34